Skilled Nursing Defined

Skilled Nursing Facilities (SNF) may be freestanding, or part of a seniors community offering any or all of the following:

  • Congregate or Independent Living
  • Assisted Living
  • A continuum of care.

The type of care that may be administered ONLY BY A NURSING HOME near you is defined by state regulations. Generally, "medical procedures" and assistive acts requiring a nurse to physically "handle" a patient are limited to nursing home providers, when not in a hospital. Changing bandages deep wounds is often only permitted in Nursing Homes as is turning a patient in bed, who cannot turn themselves.

To learn where the line between a Nursing Home and Assisted Living is drawn in your state, see regulations in your state from our state resources pages. Also, speak with the discharge planner at the hospital because they deal with the fine line between levels of care needed on a regular basis. They will know if a patient needs a Nursing Home, or can receive the care they require in Assisted Living.

Both freestanding and senior multi-level campuses (those which offer different lifestyles and/or levels of care to meet resident's needs) with a nursing facility affiliated, generally accept residents for long term stays, as well as for short term recovery. Acceptance is based on availability, the nature of care needed, and the ability to pay or their acceptance of Medicaid.

A Nursing Home may not accept an Alzheimer's patient, whose illness is too advanced for them to be safely accommodated in an Assisted Living setting. If their behavior is disruptive to other nursing home patients, who do not have Alzheimer's, they may need to move into a specific Alzheimer's Nursing Home. The physical structure and layout of a home specific to Alzheimer's patients should better meet their needs, and staff training will better be able to deal with erratic or dangerous behavior.

An Alzheimer's patient may be discharged post-surgery to a nursing home which accepts reimbursement from Medicare. As they recover and regain mobility, they may exhibit inappropriate behavior for that nursing home. There may be no nearby nursing home that accepts Medicare reimbursement that is also prepared to accept and care for an Alzheimer's patient.

What to Look For In a Skilled Nursing Facility

When difficult situations arise, families may need to turn to social workers, case workers, hospital discharge planners, and yes, the internet to help them become educated about the options appropriate for their loved one. They may also need guidance to identify specific choices in their area. Unfortunately, decisions for selecting a nursing home are often made in haste and under stressful situations.

Don't just accept the recommendation of a professional. They may mean well and understand the level of care needed, but do not know your family or your family member. They will know which homes will take Medicare, Medicaid, and which ones only accept private pay patients. But must be comfortable with the care that will be, or is being provided for your loved one. So plan to do some of your own Nursing Home shopping. Ask around. Plan to visit and see how different homes "feel," "smell," and look for those who have happier residents. Follow the guidelines below to help you shop. Try to start shopping as soon as it seems you may need to place a loved one in a nursing home. That way, you will be less stressed when you have to make the decision. If you make it in haste, it is possible to have to remake the decision later and relocate a loved one. If the first placement is hard, the second one is harder!

There is no substitute for visiting the home in person!

Federal regulations require any long-term care home or facility to provide 30 days written notice and an appropriate discharge plan if they determine a patient is inappropriate to remain with them. They may NOT just tell you verbally that you must relocate a loved one!

Skilled Nursing Facility Checklist

Basic Information:

  • A bed is available
  • The Skilled Nursing Facility is Medicaid-certified.
  • Non-Medicare patients allowed
  • The SNF provides the skilled care you need, and a bed is available.
  • The SNF has special services if needed in a separate unit (like dementia, ventilator, or rehabilitation).
  • Good reputation in the surrounding community
  • The SNF is located close enough for friends and family to visit.
  • The surrounding community is inviting and safe.

Resident Appearance:

  • Residents are clean, appropriately dressed for the season or time of day, and well groomed.

Living Spaces:

  • The SNF is free from overwhelming unpleasant odors.
  • The SNF appears clean and well kept.
  • The decor pleasing and warm
  • The temperature in the SNF is comfortable for residents.
  • The Skilled Nursing Facility has good lighting.
  • Noise levels in the dining room and other common areas are comfortable.
  • Smoking isn't allowed or may be restricted to certain areas of the SNF.
  • Furnishings are sturdy, yet comfortable and attractive.

Staff:

  • The relationship between the staff and the residents appears to be warm, polite, and respectful.
  • All staff wear name tags.
  • Staff knock on the door before entering a resident's room and refer to residents by name.
  • The SNF offers a training and continuing education program for all staff.
  • The SNF does background checks on all staff.
  • The guide on your tour knows the residents by name and is recognized by them.
  • There's a full-time Registered Nurse (RN) in the SNF at all times, other than the Administrator of Director of Nursing.
  • The same team of nurses and Certified Nursing Assistants (CNAs) work with the same resident 4 to 5 days per week.
  • CNAs work with a reasonable number of residents.
  • CNAs are involved in care planning meetings.
  • There's a full-time social worker on staff.
  • There's a licensed doctor on staff. Is he or she there daily? Can he or she be reached at all times?
  • The SNF's management team has worked together for at least one year.

Residents' Rooms:

  • Residents may have personal belongings and/or furniture in their rooms.
  • Electric beds available.
  • Do all rooms have private bathrooms?
  • Each resident has a personal storage space (closet and drawers) in his or her room.
  • Each resident has a window in his or her bedroom.
  • Residents have access to a personal phone and television.
  • Residents have a choice of roommates.
  • Water pitchers can be reached by residents.
  • There are policies and procedures to protect residents' possessions.
  • Hallways, stairs, lounges, & bathrooms
  • Exits are clearly marked.
  • There are quiet areas where residents can visit with friends and family.
  • The SNF has smoke detectors and sprinklers.
  • All common areas, resident rooms, and doorways are designed for wheelchair use.
  • There are handrails in the hallways and grab bars in the bathroom.

Menus & Food:

  • Residents have a choice of food items at each meal. Ask if your favorite foods are served!
  • Nutritious snacks are available upon request.
  • Kitchen clean and orderly
  • Does a registered dietician, or professional service, plan meals
  • Staff help residents eat and drink at mealtimes if help is needed.

Activities:

  • Residents, including those who are unable to leave their rooms, may choose to take part in a variety of activities.
  • Religious services or transportation to churches offered
  • The SNF has outdoor areas for resident use and staff help residents go outside.
  • Are there special outings
  • The SNF has an active volunteer program.

Safety & Care:

  • The SNF has an emergency evacuation plan and holds regular fire drills.
  • Residents get preventive care, like a yearly flu shot, to help keep them healthy.
  • Residents may still see their regular doctors.
  • The SNF has an arrangement with a nearby hospital for emergencies.
  • Care plan meetings help with residents and family members at times that are convenient whenever possible.
  • Provide in-house physical therapy
  • The SNF has corrected all deficiencies (failure to meet one or more Federal or state requirements) on its last state inspection report.

Your Rights in a Skilled Nursing Facility

Federal law specifies that SNF residents have these rights:

  • Freedom from discrimination
  • To be treated with dignity and respect
  • Freedom from abuse & neglect
  • Freedom from restraints
  • Informed of services & fees
  • To manage your own money
  • Personal Privacy
  • Property protection
  • Choice of living arrangements
  • Medical care information and choice of doctor
  • Private Visitors
  • Medically related Social services
  • Make a complaint
  • Protection against unfair transfer or discharge

Medicare and Skilled Nursing Facilities

Read through the government's official documentation here. People with Medicare are covered if they meet all of these conditions:

  • You have Part A and have days left in your enrollment period.
  • You have a qualifying hospital stay.
  • Your doctor has decided that you need daily skilled care given by, or under the direct supervision of, skilled nursing or therapy staff. If you're in the SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just 5 or 6 days a week, as long as you need and get the therapy services each day they're offered.
  • You get these skilled services in a SNF that's certified by Medicare.
  • You need these skilled services for a medical condition that was either a hospital-related medical condition OR a condition that started while you were getting care in the skilled nursing facility for a hospital-related medical condition.

Your doctor may order observation services to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you're getting observation services in the hospital, you're considered an outpatient—you can't count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay.

Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.

Medicare-covered services include, but aren't limited to:

  • Semi-private room (a room you share with other patients)
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy*
  • Speech-language pathology services*
  • Medical social services
  • Medications
  • Medical supplies and equipment used in the facility
  • Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren't available at the SNF
  • Dietary counseling
Medicare covers these services if they're needed to meet your health goal.

Additional Nursing Home Resources

Is your medical information available to your caregiver?
Here are some things to consider:

  • Create a Personal Health Record to distribute to your trusted caregivers
  • Keep track of all your medications and allergies
  • Carry your legal directives such as DNR, living will with you!
  • Attach your x-rays, test results and more!
  • Keep track of all your insurance claims in one place